Source: American Academy of Family Physicians
It is no secret that an increasing number of family physicians are employed. Although most physicians in other specialties are employed by hospitals or large health systems, that is not the case with family medicine. Yes, a large percentage of family physicians are employed by hospitals and health systems, but an equal percentage are employed by other physicians or physician groups.
Employed physicians should understand the payment framework of their practice for all payers, not just Medicare. Medicare clearly is the largest agitator in most practices, but understanding how you and your group is evaluated is important. Understanding how you can provide input into these decisions is essential. Learning how to best navigate this entire process should be a priority.
For better or worse, MACRA is reshaping the health care system by accelerating important practice and payment decisions at the individual physician and group level. If your practice or group is participating in an advanced alternative payment model (APM), there are several key items you should be aware of.
First, you should know and understand the set of measures by which you will be evaluated. Second, you should understand any down-side risk associated with the APM. Third, become familiar with any and all opportunities your organization has to secure shared savings. Finally, you should have, in writing, an explanation of how your group will distribute any shared savings garnered through value-based contracts.
Understanding these items will ensure that you and/or your practice receive the financial rewards consistent with your contributions to your group. Put more bluntly, don’t let the financial incentives go to the C-suite or to the organization’s coffers. Make certain that shared savings are returned to you and your primary care colleagues.
- Final MIPS scores are attached to individual national provider identifiers (NPIs), even for those reporting as a group. So, you will have an individual MIPS score, and your group will have a MIPS score. This is important.
- In the event you change practices between the performance period and payment year, any payment adjustments follow you to your new practice.
- Your performance in MIPS may impact your salary and future contracts. Given that your MIPS score can contribute to either positive or negative payment adjustments, family physicians should be prepared to see MIPS performance scores referenced in employment contracts.
- If you are a high performer under the MIPS criteria, you will have increased leverage in contract negotiations. A strong performance in MIPS should equate to a higher salary.
- Finally, you should evaluate the performance of any potential employer. If your perspective employer continuously under-performs, you should both be aware and factor that information into your decision-making process.
This information and other helpful advice is included in Making Sense of MACRA: A Guide for Employed Physicians.